It’s not suitable for women with a previous history of clots
in the veins (thrombosis). Nausea,
vomiting and
diarrhoea are the
likeliest side-effects from this drug.

Progestogen tablets

Oral progestogen tablets will cut menstrual flow when given
for long enough (21 days each cycle), as will the progestogen released from the
Mirena intra-uterine system (coil).

Mirena is
currently the most effective non-surgical way of dealing with excessive vaginal
bleeding.

There are other drug options that can be used by specialists,
if necessary, but these can be accompanied by significant
side-effects.

Hysterectomy

Heavy menstrual bleeding is the most common reason for having
a
hysterectomy.

Around 30 000 hysterectomies are carried out in the UK each
year, although this figure is falling due to an increasing number of women
undergoing endometrial ablation instead.

Complete removal of the uterus is a relatively major
operation. This means it is accompanied by risks such as the standard risk of
using an anaesthetic, surgical bleeding, wound infection and vein clots after
the procedure itself, etc.

However, these are risks that apply to any operation.

In practice, hysterectomy is a successful and well-tolerated
procedure and increasingly carried out vaginally rather than through an open
wound in the abdomen, resulting in a quicker recovery time.

Endometrial ablation

Surgical procedures other than hysterectomy to treat heavy
bleeding are now possible using fibre-optic instruments that can destroy the
lining of the uterus (endometrial
ablation).

This works because it is only the inner lining of the uterus
that is hormone-sensitive and responsible for menstruation.

The procedure does not completely remove every piece of the
uterine lining, and 30 to 90 per cent of women still get some menstrual
bleeding afterwards, but usually it is light.

If you later take HRT after an endometrial ablation, you will
still need to use a combined HRT preparation and not just oestrogen alone.

What is the menopause like?

Others suffer many symptoms and find their lives are severely
affected.

The transition into the menopause is usually gradual and is
accompanied by a range of symptoms.

Hot flushes and sweating

The most common symptoms by far are ‘hot flushes’ and sweating
attacks. These episodes can happen at any time, as often as several times an
hour.

Each hot flush usually lasts for three to six
minutes.

Exactly why flushes and sweats occur is not fully understood,
but we do know that the mechanics behind it involve the automatic controls of
the nervous system becoming erratic and the tissues becoming more sensitive to
oestrogen levels in the blood.

This triggers the skin blood vessels to open and signals the
sweat glands to become active at any time. Usually, this would only happen if
you were too hot and needed to lose heat.

Sleep disturbance

Sleeping difficulties can occur in menopausal women due to
problems falling asleep, restlessness or night-time sweats.

You may find that you sweat heavily and have to get up to
change the sheets several times a night.

Hormone replacement therapy

It involves receiving a small daily dose of oestrogen. Women
who have not had a hysterectomy are also given a progesterone-like drug as part
of the HRT. This is called combined HRT.

Combined HRT can be described as either sequential or
continuous.

Sequential combined HRT is suitable for women who are
perimenopausal, ie still experiencing erratic menstrual bleeding.

Most preparations are designed to mimic the
menstrual cycle and
result in monthly periods. They are based around a 28-day cycle in which
oestrogen is taken every day and a progesterone is added for the last 12 to 14
days of the cycle.

For women who are borderline postmenopausal and have very
infrequent bleeds, there's also a sequential preparation available that results
in three-monthly bleeds, although this is used less often in the
UK.

Once a woman has not had a natural period for a year and is
described as postmenopausal, continuous combined HRT is more suitable. This
form of HRT does not produce periods and involves taking a daily dose of
oestrogen and progesterone.

Occasionally, women aged less than 54 years old do experience
some irregular vaginal bleeding with these medications.

How is HRT taken?

There are many ways of taking HRT, with the most usual being a
daily tablet.

Alternatives include skin patches, a gel applied daily to the
skin, a ring inserted into the vagina or a nasal spray.

What are the side-effects of HRT?

The majority of women have no side-effects, but the following
are fairly common:

nausea

breast tenderness

weight gain

fluid retention.

These symptoms often settle after the first few months of
treatment. If they don't, it's worth consulting your doctor or gynaecologist to
adjust the medication.

How effective is HRT?

HRT is effective in relieving hot flushes (‘vasomotor
symptoms’) and vaginal dryness. Many women also report an improvement in their
general sense of wellbeing.

However, HRT will not help the mood swings and resultant
depression that occurs around the time of the menopause.

HRT is often taken for a short spell of six months to a year
to relieve hot flushes, but it can be taken for much longer in the case of an
early or premature menopause.

The long-term benefits of HRT have recently been brought into
question. However, the current thinking is that HRT has more benefits than
risks if used carefully and not for prolonged periods of time.

HRT can help reduce the risk of blood clots in the leg (‘DVT’)
and stroke if taken shortly after the menopause, but the risks recur if being
used after the age of 60.

The possibility that HRT users are less likely to develop
Alzheimer's disease
is still to be confirmed.

Studies suggest that HRT may offer some protection against
developing
bowel
cancer.

It has been confirmed that HRT increases the risk of
developing breast cancer and endometrial cancer (cancer of the lining of the
womb).

It can also increase the risk of stroke (in women over 60) and
ovarian cancer.

Breast cancer and HRT

HRT has been known for years to increase the risk of
breast cancer. The
risk increases with the length of time HRT is used and becomes detectable after
about one to two years of treatment.

The risk falls once HRT is stopped, and takes about five years
to drop back to the population average.

The best evidence available at present tells us that breast
cancers that occur in women taking HRT are smaller, less advanced and of a more
treatable type than breast cancers occurring in women not taking HRT.

This accounts for the fact that despite the increased numbers
of cancers arising due to HRT, the actual mortality of women from breast cancer
is the same in the HRT and non-HRT populations.

However, experts now feel the balance of risk has swung
against HRT given for longer than five years. Certainly, in women over the age
of 60, the risks of HRT start to outweigh the benefits and are significant by
the age of 70.

It's recommended that HRT is only used as a short-term
treatment to relieve menopausal symptoms and that treatment is reviewed at
least annually.

Any woman considering HRT should discuss the risks and
benefits for her individual circumstances with her doctor before making a
decision about treatment.

Other breast problems related to HRT

Women in the pre-menopause who take HRT often get breast pain
and benign breast lumps, including cysts (fluid-filled lumps).

HRT may cause benign breast lumps that are already present to
get bigger.

In the UK, as well as relying on women to check their breasts
and report changes to their GP, there is also a national screening service that
offers periodic
mammograms to women
over 47.

HRT is known to increase the density of breast tissue, which
makes it harder for the
X-rays used in
mammography to penetrate the breast.

It is therefore of concern that HRT can make it more difficult
to detect breast cancer by mammography.

However, HRT is not the only type of medicine that can be used
to relieve menopausal symptoms.

Other treatments for the menopause

Tibolone

Tibolone (Livial)
is a synthetic steroid hormone that has some oestrogen plus some progesterone
effects (and has some testosterone-like effects, too).

In a way it’s a type of combined continuous HRT in a single
tablet, which is largely how it’s used.

It helps hot flushes and night sweats, vaginal dryness and
irritation and also protects against osteoporosis.

The benefits of tibolone include much less breast tenderness
and little effect on breast tissue density in mammograms.

However, the Million Women study showed that tibolone is
associated with a slightly increased risk of breast cancer, of around the same
level as that associated with oestrogen-only HRT.

Clonidine

Clonidine is a drug originally developed for use as a blood
pressure lowering treatment, but at smaller doses (Dixarit) it can relieve hot
flushes.

However, it is not effective in most women.

Oestrogen creams and pessaries

Vaginal dryness can be relieved by short courses of oestrogen
creams or pessaries that are inserted into the vagina.

There is also a special vaginal ring containing oestrogen that
can be left in the vagina for three months, where it slowly releases oestrogen
into the vaginal tissues.

Complementary medicine

A range of ‘complementary’ medical treatments are also widely
in use to relieve menopausal symptoms.

Although the scientific evidence in favour of complementary
medicines is not as good as for conventional treatments, they are generally
safe to try.

Black cohosh is the best known of the complementary
treatments.

It has its origins among North American Indians, where it has
been used as a traditional herbal remedy for a range of gynaecological problems
for hundreds of years.

Liver damage may occur in some people taking black cohosh –
although liver injury is rare, it could be serious.

The Medicines and Healthcare products Regulatory Agency (MHRA)
have said that all products containing black cohosh should carry a warning.

Are there steps I can take to make the menopause
easier?

There has been a tendency to think of the menopause as an
illness or a health hazard, which is the wrong way to look at it. It’s a phase
of life and we have to live with it.

There is a lot of help and support that can be gained from the
medical profession and self-help groups for those women who find it difficult
to manage their symptoms alone.

Lifestyle advice is as much part of the discussion about
managing the menopause as discussing HRT – know regular exercise can help to
reduce vasomotor symptoms as well as to lose weight.

Being overweight increases the amount of adipose or fatty tissue
in the body, which tends to increase the number of hot flushes or night sweats,
as well as increasing the risk of breast and ovarian cancer post-menopause.

Regular exercise, such as walking for 20 to 30 minutes three or
four times a week, can improve your health and add years to your life. Exercise
strengthens your bones, increases wellbeing and can help make sleeping easier.

Eating the right food is also important. For healthy bones, the
body needs about 1500mg of
calcium each day from
dairy products, such as milk and cheese.

Countrychrome Azone (Tue, 19 Jun 2012 22:07:15 +0200): HOW LONG SHOULD I EXPECT THESE SYMPTOMS TO LAST, IT HAS ALREADY BEEN A COUPLE OF WEEKS, I DOn't KNOW HOW MUCH LONGER I CAN TAKE THIS CRAP, IT IS LIKE 1988 ( THE YEAR OF THE DRAUGHT ) I WAS PREGNANT WITH 1ST DAUGHTER, HOTTEST SUMMER EVER, UNTIL NOW.......LOL.....HELP!

Countrychrome Azone (Tue, 19 Jun 2012 23:56:20 +0200): I JUST NEED TO KNOW WHEN THESE HOT SPELLS WILL QUIT

Tina Devereux (Sun, 01 Jul 2012 22:01:34 +0200): The menopause has crushed the life out of me. Doctors have been of little help, and to be honest don't seem to know what they are talking about.

Evelyn Goodwin (Thu, 26 Jul 2012 08:13:48 +0200): Hi I have started taking 1000mg of Red Clover a day, within 5 days my flushes have disappeared all together

Leola Baker (Fri, 27 Jul 2012 21:58:25 +0200): I am perimenopausal for a year now. no hot flushes yet but horrid night sweats. periods were 10wks, then 12 wks, then 3 wks apart. now have a smelly discharge milky coffee in colour, in place of when a period would happen. is this normal?

Mandy Jefferies (Mon, 06 Aug 2012 18:01:46 +0200): I'm not sure if I'm going through mine yet butlast march I had my last deppo injection seen my first period march this year which lasted 14 days then didn't have another 1 till july 14 days again went to docs gave me tablets to stop bleeding stopped for 10 days 2 days later I now have another period but at night I sweat like anything even during the day feel dizzy a lot its doing myhead in.

(Wed, 10 Oct 2012 20:56:09 +0200): I lost the plot and had severe depression and anxiety. Am sure it was triggered by the menopause though I didn't think I was listened to when I put this view forward. just another neurotic woman, pat her on the head syndrome. Fortunately hot sweats have almost petered out. tiredness is accentuated though.

Colleen Hart (Wed, 21 Nov 2012 18:43:35 +0100): i think your right they dont listern and we are left thinking we have gone mad

Lupe Sanchez (Sun, 09 Dec 2012 23:02:53 +0100): I haven't had period in a year and this week I got it again.is this normal even after going thru the change of life.

Shannon Measures (Wed, 09 Jan 2013 07:03:48 +0100): Can anyone help me, my fiance and me purchased our first house together 4 months ago and have worked so hard to get to this stage and we are soul mates and couldn't be apart but she moved out on news years eve saying that she is not happy and doesn't know why and every 2 weeks she gets depressed and little things trigger her off. She is 41 and has taken on a new roll at work which is stressful and she comes home and just wont rest or take time out. She knows I love her to death and would give her the world and worship the ground she walks on. Could this be menopause? All my family and friends just can't get there heads around her leaving as this home was our dream home and how so in love we were. My 11 year old son loves her and his eyes light up every time he sees her. I'm lost to what is going on. She is the love of my life and want so much to help her can anyone help me please.

(Mon, 18 Feb 2013 17:02:53 +0100): Welll I too am going through perimenopause the worst is head shaks and off balance like iam falling over when iam walking anyone have this.....really is scarry.... let me know.. god bless us all.

Irene Stockley (Wed, 20 Feb 2013 23:26:06 +0100): I'm going through the menopause and have been told the menopause patch is good far safer has anyone got one and has it worked for you.

Margret Levine (Sat, 30 Mar 2013 00:11:54 +0100): When I first started to suffer from perimenopause, I was searching avidly, and it's great to see articles with good info like this. Recently, I found this documentary called "Hot Flash Havoc", and it answered LITERALLY every question I had about perimenopause and menopause, as well as addressing every single damn treatment on the planet. It was also nice to see what other women were going through in comparison. Going through hell is a lot easier when you have others to relate to. Check it out, it's worth it.
http://bit.ly/11Wg60V

Shanna Naja (Tue, 06 Aug 2013 09:07:08 +0200): I have not had a period in eight months. I am 48 and am physically fit. The only thing is I have horrible night sweats. Am I too young for menopause?

The materials in this web site are in no way intended to replace the professional medical care, advice, diagnosis or treatment of a doctor. The web site does not have answers to all problems. Answers to specific problems may not apply to everyone. If you notice medical symptoms or feel ill, you should consult your doctor - for further information see our Terms and conditions.